Wednesday, December 08, 2010

Health Care in NB

David W. Campbell writes, "We have over 11,000 more workers in health care today in New Brunswick compared to 1999 with no real evidence of better outcomes. We are spending $1.2 billion more this year than in 1999 on health care." Implicit in this argument is the supposition that the level of health care in 1999 in NB was adequate. It was not.

I moved here in 2001 and it took me years to find a family doctor. We simply could not obtain prescriptions for things like asthma medication. It still takes far too long to obtain service on some kinds of treatments.

I don't know what the evidence is (or isn't) that there is "no real evidence of better outcomes" but I'm quite sure I'd like to see it presented. In my own household, the level of health is much better today than even five years ago. I can document it pretty easily. But I am not sure how this would translate into evidence of outcomes.

Yes, I use health services more now than in the past. That is because, in the past, I was not able to access health services at all. There were no clinics, there was no way to see a physician, the only point of access was through the emergency room.

I would want to see more evidence that 'greater awareness of the costs' would impact usage of the health care system. When you're sick, you're sick. People would love to be less sick, but it doesn't work that way.

I'm sure there are ways to reduce health care costs and to improve outcomes, but they are a far cry from the sort of solutions the privatization set proposes.

- address income inequity. The gap between richest and poorest in NB is among the widest in Canada. There's plenty of research showing health care costs are reduced with income gaps are lowered. The Globe and Mail published more evidence of that today.

- improve points of access. The biggest shock for me on moving here from Alberta was not the hospitals (though, honestly, NB hospitals were 20 years behind Alberta's). It was the complete absence of drop-in clinics. Now we have more clinics, but they are not well-advertised and you still have to book an appointment.

- manage bookings and appointments with computers. Make (and keep) appointments. I mean, seriously now. The NB system has yet to enter the computer age. Here's how bookings work now: your doctor will send a referral (by paper) to the specialist, and then some time in the future, the specialist will phone you. Appointments? Scheduling system? Not in NB. Those of us who are newcomers are quite certain that locals are called first, with the rest of us getting the leavings.

- invest in education. When you launch services like tele-health, advertise it (I learned about it originally only when my doctor told me). Use the media to describe the system to people, the different ways to access it, and the appropriate ways to do so. Also, media about general health, health issues, and similar campaigns is essential.

- stop threatening people with privatization. Big business would love to own the hospitals and insurance system. We get that. But it doesn't help anyone to have them constantly lobbying for reductions in services, reductions in expenditures, methods for tracking fees, etc. Make it clear that the hospitals are a public service, for the good of NB, and will not be privatized.

Remember, investments in health care are net gains for the province, not line-item expenses. Health care is absolutely essential in order to attract and retain population and industry. We should be using our health care as a selling point, not trying to explain away the expenses as mismanagement and abuse. Health care can form the basis for an economy - a big part of the resurgence in Moncton over the last decade is the provision of health care services around the hospitals - everything from clinics to pharmacies.

Whether privatization is a threat or not depends on ones perspective and there are many who are quite happy to be able to pay for a service whenever they want it rather than having to wait in line. This and efficiency are almost always the points used by those promoting privatization whether business owners or not. To really knock the wind out of the sales of those promoting privatization, there is a need to get better outcomes with the money spent so that throwing $1.2 billion at a problem does result in improvements.

Wellescent, the problem with privatization is that (a) there are still lines, unless you're wealthy, (b) it's no more efficient, (c) you get demonstrably worse outcomes, and (d) the entire system costs twice as much.

There is, though, no end to the number of companies and individuals who don't mind weakening the entire system in order to ensure they they augment their own wealth, and they will say whatever they need to say in order to wreck the system we now have.